Tag Archives: npd

Do we want people to believe that BPD is a real psychiatric illness that they must manage for the rest of their lives, or do we want to promote a message of hope which says, “You can become free of your emotional distress and live the life that you want”?

By presenting BPD as a severe mental illness which can be managed but not cured, the medical model of the BPD label utterly fails to promote hope. Additionally, the medicalized concept of BPD is scientifically broken: It does not describe a valid illness which is consistent across a population.

Why do we keep using BPD if there is so much wrong with it? Is it possible that we would be better off without BPD?

And if BPD is should be abolished, what should replace it?

This article addresses how to replace BPD.

To this question, my first answer is “Nothing” – that we should simply abolish BPD – and my second answer is “Emotional Dysregulation Susceptibility Syndrome”, which I will explore as a hopeful alternative. Let’s discuss these options.

My central conceptual argument is that Borderline Personality Disorder as defined in the DSM is an unreliable, invalid concept. Given its current popularity, it’s not easy to fight against the prevailing notion of BPD as a valid mental illness. But after speaking to many people who also experience BPD as a flawed, discouraging concept, I am more resolute in this view than ever. If you are unfamiliar with the argument against BPD, please see here, especially Myth #5:

While I prefer to understand people without labels, due to practical considerations I contend that BPD should be replaced by a more hopeful label. This new label should refute the myth of BPD as a life-long mental illness and emphasize vulnerability to stress along a continuum.

My position against BPD directly opposes the thinking of many in the psychiatric establishment, including large organizations like TARA BPD, the Treatment and Research Advancements Association for BPD, and NEA BPD, the National Education Alliance for BPD.

TARA and NEA assert that BPD is a “serious psychiatric illness”, one which they can reliably investigate and for which they will create improved treatments. In my opinion, these medicalized viewpoints represent poor research and outright misinformation.

Let me list and critique some of National Education Alliance BPD’s main positions. I hope the reader will sense how badly NEA’s claims on BPD, which often border on outright lies, fail to meet the criteria for good science and basic common sense.

1) BPD is an “illness”.NEA’s position: BPD is a single illness which causes unstable mood and behavior.Edward’s response: BPD is not one unitary entity that causes anything. BPD is not a single illness because the symptom-cluster that supposedly represents BPD cannot be reliably identified by any biomarkers (genes, brain scans, etc.) nor reliably identified by different psychiatrists across a population, as the NIMH recently admitted.
The way a person understands their world based on past experience leads to unstable mood and behavior.

2) Genes are involved in causing BPD.NEA’s Position: Scientists generally agree that genetic and environmental influences are likely to be involved in causing BPD.Edward’s response: This is misleading on so many levels it’s hard to know where to start. Again, BPD is not one reliable entity. And there is no evidence that genes “cause” any of the distress-experiences denoted by the BPD misnomer – such thinking involves the mistaken assumptions that genetic and environmental factors work as separable influences in a quantifiable manner. I have written about these distortions extensively in my article on twin studies (#4).

3) Brain scans provide evidence that biological factors cause BPD.NEA’s position: There is evidence that biology is a factor in causing BPD, due to imaging studies in people with BPD showing abnormalities in brain structure and function.Edward’s response: Does NEA think the public cannot understand basic cause and effect? Of course seriously distressed people have observably different brains than “normals”. That doesn’t mean biology or genes cause these differences; neglect, abuse, and lack of love, which are much more prevalent in those labeled “borderline”, inevitably lead to different brain functioning. But that doesn’t even mean those things cause BPD or that BPD is real. Never take a difference for an illness.

4) Biological factors make people more likely to develop BPD.NEA’s position: The current theory is that some people are more likely to develop BPD due to their biology or genetics and harmful childhood experiences can further increase the risk.Edward’s response: The current theory is a demonstrably false hypothesis. Constitutional vulnerability to stress may make it easier for some people to become overwhelmed by environmental stress, but that doesn’t mean that BPD is in any way a valid illness, nor that such people cannot become well. Plus biology and genetics do not act alone in the way implied in this reductionist model (see – http://www.madinamerica.com/2015/06/are-dsm-psychiatric-disorders-heritable/ )

5) The prevalance of BPD can be quantified.NEA’s position: BPD affects 5.9% of adults at some time in their lifeEdward’s response: Does anyone really believe that a subjective, descriptive label with no biomarkers can have its prevalence reliably identified to a tenth of a percentile?

6) BPD is a life-long mental illness.NEA’s position: People with BPD have BPD for life. (NEA stops short of saying this outright, but they imply it. Their website talks over and over about managing and reducing symptoms in “borderlines” of different ages, never once mentioning the possibility of becoming free of “the illness” or discussing the possibility of full recovery)Edward’s response: This is one of the most damaging myths being promoted about BPD. Problems that are mislabeled BPD can be fully recovered from; people who once approximated borderline criteria can eventually live a satisfying, emotionally normal life. Many thousands of people have already done so. Getting better is hard work, but people do not have to cope with and manage BPD for life. People need real hope, not the discouraging prospect of a life-long illness.

My Manifesto Against National Education Alliance for BPD

As can be seen, NEA BPD set themselves up as the experts on how to define and treat the BPD “illness”, an illness label they obviously intend to keep. But they may not have considered that former “borderlines” can see through their propaganda.

My position on NEA’s “BPD as a serious psychiatric illness” notion is this:

Severely distressed people do not have accept the label BPD as an identity nor as an explanation for their problems.

Emotional problems are not reducible to “psychiatric illnesses”, nor are they the exclusive province of psychiatry.

Effective help which often leads to full recovery from problems mislabeled BPD already exists. Recovering does not require the assistance of “experts on BPD”, nor does it require DBT and medications, although these can help. Also, people can have their own definition of recovery and a meaningful life.

Emotional problems mislabeled BPD can be completely healed and do not have to be managed for life.

It’s time to say goodbye to National Education Alliance’s harmful theories about BPD as a life-long psychiatric illness, to end the borrowed time these theories have been living on.

Why Reducing BPD’s Stigma is Doomed to Failure

I also oppose the message of blogs that attempt to put a positive spin on BPD, like “Make BPD Stigma Free”. In my opinion, reducing BPD’s stigma and building “BPD Pride” is doomed to failure. To me, these efforts resemble shifting deck chairs around on the Titanic. Similar attempts to reduce depression’s and schizophrenia’s stigma have foundered miserably; the problem is that reducing complex emotional issues to medical labels explains nothing and fails to empower people.

Two examples of such programs are instructive:

“Defeat Depression”, a large scale British campaign to reduce the stigma of Major Depressive Disorder, failed to reduce stigma and did not improve outcomes according multiple follow-up studies.

“Beyond Blue”, an Australian attempt to reduce the stigma of so-called mental illnesses, also backfired. Studies investigating its effect found that those who knew less about mental illness diagnoses, or who were given a diagnosis but rejected it, had better outcomes than similar people who believed they “had a mental illness.” This unsettling finding has been confirmed in John Read’s research (e.g. Models of Madness).

The disturbing conclusion of this research is that accepting that you have a “mental illness” – as opposed to rejecting the medical model of emotional distress – actually decreases the chances of recovery. This shocking Youtube presentation by critical psychiatrist Sami Timimi covers this and other eye-opening facts about “mental illness”:

If Defeat Depression and Beyond Blue failed to destigmatize depression, why should a destigmatization program for BPD succeed? Alongside “schizophrenia”, BPD is the most unreliable, invalid, confusing, harmful, stigmatized, and useless label. Even if BPD were to lose its stigma, it would remain an unreliable term that explains nothing about an individual’s problems.

Abolishing BPD – The Ultimate Goal

Borderline Personality Disorder can and should be entirely abolished. BPD should be consigned to history as a tragically misguided way of
concretizing emotional distress.

2) Label-Free Treatment: Psychotherapists and treatment programs would help distressed people without viewing them as borderline, no matter how much the client “fit” that outdated term.

3) Label-Free Family Understanding: Families would be helped to support their distressed members without being fed the fiction that their loved one “has BPD.” Parents, siblings, partners, and children would find that their loved ones’s problems can be understood without calling them borderline.

4) A New Research Paradigm: into severe emotional problems would cease to be focused around BPD. It would instead use the emotional dysregulation spectrum concept that I’m going to discuss. There would be more qualitative, experience-focused research, and less quantitative label-focused research.

5) Abolition of BPD and the DSM: BPD would be abolished from the DSM, as it has already been removed from ICD (Europe’s version of the DSM, from which BPD was recently voted to be dropped). Furthermore, as an unscientific fraud full of fictional illnesses, the entire DSM would be eviscerated.

In time, BPD would be viewed as an outdated relic, a sad symbol of an age where psychiatrists constructed bizarrely misguided labels for emotional distress. People in the year 2200 would look back on “BPD” in disbelief, much as people today look back at centuries-old conceptions of physical illnesses. BPD would be mocked alongside notions of evil spirits released by bloodletting and plagues caused by divine curses.

A BPD-free world is possible. People often underestimate what can be done over long periods of time with sustained, gradual effort. Perhaps BPD’s life is already growing short.

How Would We Understand People Without BPD?

What a scary idea! How could we ever understand people showing “borderline” symptoms without labeling them with BPD?!

How do we understand the problems of anyone we care about?

1) Listen to their story. Learn about what past and present experiences are causing their distress. Develop a shared understanding of their problems based on their history.
2) Learn about what they want to change in the future. Develop a shared understanding of their needs and dreame.
3) Understand fundamental human needs for security, dependence, respect, and independence.

These are the fundamental steps in the Formulation approach to emotional distress, as described here in the story of Emma:

People labeled “borderline” can be effectively helped without labeling them as BPD. But because of the reductionist ideology that has crippled the minds of too many mental health “professionals”, abolishing BPD without a replacement label may be a bridge too far. The Big Pharma profit incentives which maintain the need for medicalization of emotional distress present another obstacle.

The First Step Toward Abolishing BPD – A New Name

Supported by the public’s ignorance about what a precariously perched house of cards “BPD” really is, the profit motives of psychiatrists and Big Pharma will likely block a total abolition of BPD, even though BPD paradoxically never existed and does not exist today. Therefore, I suggest the intermediate step of renaming BPD, something which has already begun to happen for other pseudo-illnesses such as “schizophrenia”.

If done well, renaming BPD would accomplish multiple goals:

1) Undermine the false conceptualization of emotional distress as an illness that is consistent from person to person.
2) Emphasize that emotional distress varies along a continuum and that people labeled “X” are not always “X” (i.e. are not always distressed, but are vulnerable to stress).
3) Reduce stigma by introducing a fresh name without negative connotations.

Despite these hopeful goals, one might argue that replacing BPD with another name would lead to just as much stigma and misunderstanding.

But could a new name truly aspire to be as miserably uninformative as Borderline Personality Disorder?

Would BPD by any other name smell just as bad?

I doubt it.

Japan, Jim Van Os and the Abolition of Schizophrenia

I’ve gone through some brainstorms about what BPD could be renamed, drawing on the campaign against “schizophrenia” for ideas. Many people are calling for schizophrenia to be abolished, and Japan legally abolished schizophrenia about 10 years ago

(Yes, there really are no more “schizophrenics” in Japan. They have a new, less-stigmatizing name for psychotic distress, meaning “integration syndrome” in Japanese, and people undergoing psychotic episodes are no longer called schizophrenic. The entire Japanese government-recording and psychiatric-labeling system for psychosis has been changed. See here – http://www.schres-journal.com/article/S0920-9964(09)00140-6/abstract ).

Van Os renames schizophrenia, “Psychosis Susceptibility Syndrome” , or PSS. The name implies that psychotic experience occurs along a spectrum of severity, involves vulnerability to environmental stress, and that people who have been psychotic in the past are not always psychotic today. In this model, “schizophrenia” as a discrete illness is meaningless and false.

If BPD were renamed Emotional Dysregulation Susceptibility Syndrome, what would that mean? The EDSS concept would contrast with BPD as follows:

1) Spectrum, Not Illness: EDSS represents a spectrum or continuum of increasing vulnerability to emotional distress. Despite similar appearances, people vary along this spectrum both in degree and kind of distress experienced. People would have more or less “EDSS” in relation to others and themselves at different times. EDSS is therefore not one illness, but a spectrum of related conditions – it refutes the misrepresentation of BPD as an internally reliable illness.

2) Vulnerability, Not Illness: EDSS represents a heightened susceptibility or proneness to emotional distress, usually correlated with neglect and abuse in childhood. EDSS itself does not cause distressing symptoms; rather, it represents the heightened likelihood of environmental stress causing these distress experiences. Compared to BPD, EDSS gives more weight to what happens around a person, rather than to isolated non-contextual internal experiences. EDSS is a syndrome – again meaning it represents similar-appearing experiences which do not necessarily reflect a consistent underlying illness.

3) Recovery and Freedom, Not Management: EDSS represents a psychological state that someone can be in at a certain time of their life, but can grow out of and be free from at a later time. It is in no way a lifelong condition. With effective help, people have a good chance of moving out of the EDSS spectrum for good. This refutes one of the most damaging lies about BPD: That BPD is a life-long illness.

(If you could rename BPD, what would you call it and why? Or would you keep BPD? Let me know in the comments.)

A Psychodynamic Model of the EDSS Continuum

Drawing on my psychodynamic background, I conceptualize Emotional Dysregulation Susceptibility Syndrome as a continuum marked by a relative deficit of positive self/object images, combined with a predominance of all-bad images of self/other within a person’s mind. The deficit of good internalized experience and the predominance of all-bad self/other images would usually correlate with neglect, lack of love, abuse, or trauma caused by parents and peers in childhood and young adulthood. I developed this model fully here, drawing on the “master theorist” of borderline-spectrum conditions, Ronald Fairbairn:

The deficit of all-good images leads to the inability to comfort oneself when under stress (i.e. emotional dysregulation), and to the increased susceptibility to stress relative to most emotionally-healthy people who had more consistent past and present support. All the other distress experiences commonly labeled “borderline” – e.g. destructive acting out, lack of identity, rapidly shifting moods, extreme rage, splitting, etc. – would be understandable results of having to cope with the missing self-comforting functions that can only be provided by a predominance of good self/other images over bad self/other images, i.e. enough good experiences in one’s past to reassure oneself when under present-day stress.

These distress experiences would also be understood as present-day replayings of past trauma; i.e. as the projection of the all-bad self-object images internalized in childhood onto others in the present, which make the person experiencing EDSS feel that they are “bad” and others are rejecting or unavailable.

EDSS might also be conceptualized as the spectrum encompassing the “Out of Contact” through “Ambivalent Symbiotic” Phases in this 4-phase model:

These descriptions do not represent an illness, but rather a dynamic state of relating to oneself and others at a certain time. One can function at any point along the spectrum from almost Non-EDSS to very severe EDSS – i.e. from approaching a normal range of being able to comfort oneself and function well, with only occasional regressions into serious distress – down all the way to very severe EDSS, in which the distress experiences are constant and severe to the point that normal functioning is not possible. Hopefully that the paradigmatic differences between BPD and EDSS are clear.

You Don’t Have to Accept the BPD Label

I hope these ideas will be encouraging and provoke thought about whether BPD really is valid and useful. Replacing BPD might seem unthinkable now, but there were times when women voting seemed impossible, when black people being free seemed impossible, and when tobacco causing health problems seemed impossible. Radical change can happen. Often, the process leading to a dramatic change is gradual and unseen, like when decades-long pressure building under the Earth’s crust goes unnoticed before an earthquake.

If a small but growing number of people reject the BPD label, this process can build momentum toward renaming and/or abolishing BPD. I encourage everyone reading this who has ever been labeled “borderline” to consider that you no longer have to identify with or accept BPD, period.

If a psychiatrist labels or has labeled you as BPD, or if the voice of people calling you borderline is stuck in your mind, I encourage you to tell them something like this:

“The BPD label you’ve called me is a simplistic checklist of distress factors, factors which anyone under stress for long enough can experience to different degrees. There are no reliable genes, brain-scans, or other biomarkers which can identify so-called BPD. In fact, BPD is in no way a reliable classification; it is an “illness” fabricated out of thin air without a basis in real science.
There is therefore no proof that I have an illness like you say, or that there is anything innately wrong with my brain; most likely, I am reacting in a perfectly logical way to the stresses I’ve gone through. There are other, better ways to understand my problems, and I do not accept the false label of BPD that you are putting onto me. If I get enough help, I can fully recover and live the life that I want.”

Psychiatrists and therapists need to hear this from more of the people they call “borderline”!

Where did BPD come from, and how was it passed down to modern humans? This is one of the more vexing questions of our age. For an answer, we must turn to the all-knowing wisdom of American psychiatry, which proclaims:

“BPD is strongly inherited.” This seems like an answer to where BPD comes from. But is it? According to psychiatry, BPD is mostly in the genes. But how could this dreaded disease have originally developed? It didn’t magically appear out of thin air. This begs the question: From whom was BPD first inherited? Who – or what – was the real “first borderline”?

In this essay, I will take psychiatry’s thinking to its logical conclusion. If BPD is “inherited”, we should be able to track down the ultimate source of this nefarious malady. Prepare to embark on a fascinating journey of discovery. My theories are based on exciting new research by paleo-psychiatrists – scientists who study mental illness in prehistoric creatures.

Early Speculations on BPD’s Origin

Early paleo-psychiatrists raised questions like the following in their search for the first borderline:

Was the first borderline an Egyptian slave who began to have mood swings under the stress of building the pyramids, 4,000 years ago?

Was the first borderline a Bronze Age Mesopotamian mother who, traumatized by hard farm work, began to view her fellow Sumerians as saints or devils, 8,000 years back?

Or was the first borderline an Aboriginal hunter-gatherer who, after too many attacks by dingo dogs, developed identity diffusion in the Australian outback 12,000 years ago?

Did one of these ancient people first become borderline, and then transmit the invisible plague to their prehistoric children and on to us?

(Aside: Recent genetic studies by paleo-geneti-psychiatrists have suggested that, in addition to the normal gene-coding letters A, C, G, T, the nucleobases B, P, and D are present in the genomes of people with BPD. So genes in a healthy person, which originally read GATCGGCAGGAACAT, would come to read GATBPDCAGBPDGAABPD. This is why I’ve been terrified to get my genes mapped, for fear those cursed combinations will appear in my DNA strands, to be inevitably passed on to my children.)

BPD and Early Man

Returning to the main story, the answer is no. BPD extends back far past early Egyptians, Mesopotamians, and Aborigines. Paleo-psychiatrists recently found that cavemen exhibited Borderline Personality Disorder. Witness the following image, found on prehistoric cave walls at Laschaux, France, but concealed from the public until now:

With this life-like painting revealed, it is scientifically proven that BPD extends at least to our caveman ancestors. This is so easy to figure out, even a caveman can do it.

So perhaps BPD originated with these forward-thinking cavemen, who would have been traumatized by living in rotten, damp caves. But couldn’t cavemen have inherited BPD from earlier humanoids?

Through the theory of evolution, we know that humans evolved from early apes (or at least, people who think the earth is more than 6,000 years old know this). So maybe the situation looks more like this:

These monkeys are not going to tell us anything definitive, but that bonobo looks suspicious.

Prehistoric Megafauna and BPD

Early apes are an interesting potential source of BPD. But other evidence suggests that the vile pathology worms its way back further. Each of these early humans and apes evolved from other life-forms, any of which could have been the first carrier of the abominable affliction. The plot thickens, and if we want to know where BPD truly came from, we must gaze deeper into the past.

Paleo-psychiatrists recently found this fossilized face-off between the last saber-toothed tiger and the first prehistoric mountain lion. From their facial expressions, it was deduced that they were snarling the following at each other:

But of course, if prehistoric big cats had borderline symptoms, it begs the question of where they inherited them from. Peering further over the horizon, here is cave art drawn by a Paraceratherium, revealing fantasies it was having about the cause of its family’s BPD symptoms:

So in this image, we have evidence that BPD existed at least 15 millions years ago, in the age of the megafauna or giant mammals. But there’s more.

Psychiatry’s Return to the Days of the Dinosaurs

Excited by their study of the megafauna, paleo-psychiatrists dug ever deeper into forgotten times. The two creatures below were recently unearthed from a prehistoric swamp after being buried by a 65-million-year old mudslide. Paleo-psychiatrists determined that they were saying the following:

Well, this picture is not exactly about BPD. But given the high comorbidity between Avoidant PD, Narcissistic PD, and Borderline PD, it can be said with confidence that BPD dates back at least 65 million years. If avoidant and narcissistic dinosaurs roamed early Earth, then giant reptilian borderlines would have been lumbering around too.

Indeed, all sorts of personality-disordered dinosaurs must have existed in the Cretaceous, Jurassic, and Triassic eras. This makes it much more difficult to trace who the first borderline was. But it does enable us to watch The Land Before Time and Ice Age: Dawn of the Dinosaurs with a new understanding of these monsters.

The search begins to seem endless. Who was the real first borderline? This situation brings to mind the Where’s Waldo? books, when you can never find the little guy in red and white stripes. Or perhaps it should be Where’s the Borderline?:

Sorry. Back to the topic at hand.

Early Avian and Mammalian Ancestors

As I was saying, paleo-psychiatry keeps making new discoveries. To trace the passage of the fearsome plague that is BPD into humans, we should also investigate the earliest birds and mammals, who shared common ancestors and lived alongside dinosaurs. Early mammals lived in a traumatic environment, which we know is a risk factor for BPD. Perhaps the trauma of living with big, scary dinosaurs was transmitted into their genes, creating a vulnerability that led to BPD in humans.

One can imagine the following scenario:

As well as this one:

It makes sense that borderline traits might develop and be genetically transmitted in such an environment. But couldn’t BPD have developed in pre-dinosaur times, and been transmitted from an even earlier starting point?

A Never-Ending Goose Chase

We must commend paleo-psychiatrists for their efforts to trace the early animal origins of BPD, efforts which are as scientific and respectable as those of modern-day psychiatrists to study BPD in humans.

But despite heroic efforts, paleo-psychiatrists have not traced BPD’s ultimate origin, which remains shrouded in mystery. It seems straightforward to follow the evolution of BPD from modern day humans, past cavemen, through early mammals and dinosaurs, all the way to the earliest forms of life. But this process never reaches a satisfying conclusion. With evolution working as it does, there would always be another creature from which to inherit BPD.

We can even imagine unicellular cells, flitting around the primordial fires of early Earth, transmitting their borderline traits to the first multicellular organisms:

But let’s not go there.

Creationism – A Solution to the Conundrum?

There is another possibility. What if evolution is wrong, and another theory explains BPD’s origin and heritability? What if Earth is only 6,000 years old, as creationists solemnly preach, and as some of our finest public schools teach as an alternative to evolution?

Creationism would elegantly explain how BPD developed. Under creationist teaching, BPD would be a result of the trauma that early humans experienced living alongside dinosaurs and other “prehistoric” creatures. If God created the Earth 6,000 years ago, he would have put all the creatures in history together, even if it resulted in strange alterations to traditional Biblical stories, like this:

And this:

And this:

No wonder the authors of the Bible wanted to cover up this sordid state of affairs. Living alongside dinosaurs would have made things scary and unpredictable for early humans. And as we know, such traumatic environments are a prime cause of BPD. Therefore, 6,000 year-old dinosaurs may have been the primary reason that BPD developed and was genetically passed down from early to modern humans.

Thus, the trauma of living alongside these monstrosities would have affected mankind’s genes such that BPD would quickly develop as a distinct disease. As Jonathan Swift might have said, this is “a modest proposal”, but a convincing one.

Just imagine the following scene, which would have been a daily occurrence 6,000 years ago:

And this:

Who would not develop borderline symptoms in such conditions?

And imagine having to live alongside abominations never preserved in the fossil record (the fossil record having been planted to trick creationists into believing in evolution, of course), like this:

How horrifying! Thank goodness the dinosaurs and swamp-monster abominations were finally wiped out in an almighty Ragnarok-like battle against invading aliens:

If dinosaurs and aliens had not annihilated each other a few thousand years ago, then modern civilization would never have developed. If dinosaurs did not die out, we poor humans would have been stuck with dinosaur-induced BPD symptoms, but without the gentle ministrations of modern psychiatry to help us manage them. So let us give thanks that aliens and dinosaurs wiped each other out, because DBT wouldn’t be possible with Tyrannosaurs constantly chasing us.

For me then, creationism provides the best explanation of BPD’s origin. It seems that we must renounce evolution, and accept the fact that the Earth is only 6,000 years old, since no other theory explains BPD’s origins so simply and elegantly. Remember Occam’s Razor – the simplest explanation is usually the correct one.

Alternate Explanations: Pastafarianism

However, there are other explanations. I was recently contacted by a Pastafarian paleo-psychiatrist, who suggested that the Flying Spaghetti Monster might be the cause of BPD. (For those of you who don’t know, Pastafarianism is the religion which teaches that a Flying Spaghetti Monster created the universe. Visit the Church of his Noodly Appendage at http://www.venganza.org )

So, instead of this scenario leading to BPD:

The following scenario would have accounted for the illness:

However, try as I might, I cannot think of a real reason why the Spaghetti Monster would want to create BPD. His job is to create the universe and feed people pasta, not generate mental illnesses. So this doesn’t fly with me, even if the Spaghetti Monster “flies” in another way.

The Scientific Integrity of My Research

For those of you who think this is a joke, it is not. Do not hurt my feelings by commenting that these theories are unscientific. I am earnestly supporting the efforts of our nation’s finest psychiatrists in tracing the source of BPD, a pathology which even they admit “the causes and origins of are unclear”. What could be more noble than shedding light on the origins of such a misunderstood affliction?

The Learning Doesn’t Stop Here

Despite their confusion around the inheritance issue, there is much more to be learned from psychiatry’s penetrating insights into BPD.

Psychiatry wisely teaches us that BPD is a “severe illness”, that BPD has a “course” and an “outcome”, that a certain percentage of the population “has it”, how psychotherapy and medications can “manage it”, and so on.

We must give thanks to psychiatry for creating such a wonderful and sympathetic way of understanding human emotional problems. Hearing the pontifications of psychiatrists on BPD is like listening to beautiful classical music.

If you want to learn more about these encouraging, scientifically-sound ideas via our government’s finest websites, as well as from many forums about BPD, make sure you are prepared. Before you research BPD’s cause and origins on Google, you will need:

A good sturdy chair.

A thick pillow to keep your ass from getting sore.

Eyedrops

Pain relief ointment for your mouse-clicking finger.

Tissues

Headache medications.

And take heart: Everything you learn about BPD from traditional psychiatry will be just as scientifically valid as my research above. Good luck!

The Scientific Process by which BPD Sprang Into Being

Now, if BPD first developed in early humans living alongside dinosaurs – who wouldn’t have referred to their symptoms as “Borderline Personality Disorder” – it is interesting to consider when the term BPD first emerged in modern psychiatric usage. Below is an imagining of the scientific process by which BPD may have developed.

A Conversation Between Two Medical Doctors of the Mind (i.e. Psychiatrists)

(Setting – Drs. Chillingworth and Hadley are smoking it up outside a beautiful hotel, discussing the current state of the psychiatric art..)

Dr. Chillingworth: “I’m so thrilled to be back at our nation’s premier psychiatry conference. Our catalogue of mental afflictions is crying out for new names. You know, my dear Hadley, I don’t think we’re upsetting people enough by calling them neurotics and hysterics. The masses need to know when there’s something wrong with them, and those labels just don’t do it for me anymore. We need something to really get the blood boiling.”

Dr. Hadley: “I agree, dear Chillingworth. I call the crazy ones schizophrenic, but they don’t even react! It’s most disturbing. I wonder where we’ve gone wrong.”

H: “How about “Weirdo Syndrome”? You know, for the bizarre folks who aren’t totally crazy, but we don’t know what else to call them?”

C: “Oh humbug! Is that the best idea you have?!”

H: “Forget that. What about “Queer Disorder”. It could be a brand new affliction. We know there’s something wrong with the homos; everyone suspects there’s a malignant germ plasm in their blood!

C: “No dice! Our friend Dr. Beavis beat you to the punch – he’s presenting this idea tomorrow. Don’t worry, homosexuality will be an official disorder. Come on, we need something original!”(Historical note: Homosexuality was an official DSM disorder until the mid 1970’s).

H: “How about….. “borderline”? We can use it on the ones who aren’t neurotics, but aren’t raving psychotics? You know, the people who are always pissing me off.”

C: “Yes!! Yes. That’s it. … “Borderline!” Wow…. It’s a bunch of bullshit – it doesn’t mean anything. But that’s why it’s brilliant. People won’t know what it means, so it will work perfectly. Let’s use it!”

H: “But how can we be sure that people will buy it, Chillingworth?”

C: “That’s easy. We list things about people who aren’t raving psychos, but are “messed up”. We say if you fit enough of the criteria, you’re a borderline! We make it all sound very scientific and official. The criteria could be things like being irritable, having mood swings, having relationship problems, being impulsive, etc. etc. Things anyone can have, taken to an extreme. Anything we can make up about people we don’t like.

H: “But do you really think people will believe that? I don’t know…”

C: “Of course they will! Give yourself some credit, Hadley; stop overestimating your fellow human beings. Most members of our species are uneducated idiots. If psychiatrists repeat a made-up label loudly and often enough, people will believe it. Remember, the public think we’re experts.”

H: “This is great! But you know, I just realized something, Chillingworth. You’re pretty messed up yourself.”

C: “Tell me something I don’t know!”

H: “Indeed. Moving on… do you think that, many decades years from now, people might think this “borderline” label we dreamed up is real, and a whole industry will be based around labeling and managing these “borderlines”? I don’t know if I would feel good about that.

C: “Oh stop whining! The Borderline affliction will become real, because we say it is. We became psychiatrists so we can be exalted as experts and given bundles of money. Who cares if we have no idea why people act like they do? And who gives a damn about people in the future? Our genius is that we have no idea what we’re talking about, but people pay us anyway. Have faith, my friend.”

And thus was born “Borderline Personality Disorder.”

(Historical note: BPD was in fact “born” after psychiatrists in the late 1930s invented the term out of thin air. Perhaps not exactly like this. But close enough…)

If you are struggling with BPD yourself or would like to more effectively help someone who is borderline, I would be happy to listen to your story and provide feedback if possible. Feel free to provide constructive criticism of this site also.

This article is the opinion of a non-professional layperson, and should not be taken as medical advice or as the view of a therapist who is professionally qualified to treat Borderline Personality Disorder or any other mental health condition. Readers should consult with a qualified mental health professional before undertaking any treatment

For the purpose of understanding psychiatric problems in a more nuanced and optimistic way, here is a diagram from Donald Rinsley’s book Treatment of the Severely Disturbed Adolescent:

Please click on the picture to see it larger. Each row corresponds vertically to the rows above and below in describing degrees of emotional development, and each row describes emotional growth over time from left to right. The majority of the text in brown is Rinsley’s own diagram; the bottom additions in white are mine.

Donald Rinsley was among the most respected authorities on borderline and narcissistic conditions in the second half of the 20th century. He was a psychodynamic therapist who ran a psychiatric hospital for severely troubled adolescents in Topeka, Kansas in the 1960s, 70s, and 80s. He later worked extensively with personality-disordered and psychotic adults in an outpatient psychotherapy practice.

I believe that much can be learned from studying Rinsley’s diagram. It explains how psychiatric diagnoses were originally understood in psychodynamic theory – as problems in relating and functioning that occur along a continuum of severity and merge into one another. In other words, psychiatric conditions are not distinct disease entities; there are no clear lines that separate one from another.

At the upper and lower ends of each “disorder”, one cannot confidently say that a person is, for example, a higher level borderline versus a lower-level narcissist, since the conditions fade into one another. Note how the arrows denoting each region don’t stop before running into each other; they overlap.

In this row, Rinsley lists phases of healthy child development that, when interrupted, can cause arrests in emotional development – i.e. psychiatric problems. Roughly, autism (which does not refer to autism as understood today) refers to the earliest period when a baby is unaware of the external world and feels fused with its mother at a body-level. Symbiosis is when the child starts to relate in a back-and-forth need-fulfilling way with its mother.

During differentiation, the baby realizes that it is separate from its mother psychologically as well as physically. In practicing, the child discovers and explores the external world via its newfound ability to walk. And in rapprochement, the child develops a good relationship to the mother as a separate person and faces conflicts around dependency/attachment and independence/autonomous functioning.

In these descriptions, “mother” is synonymous with “caretaker”, “parental figures”, and “the external world of people”. In the object constancy phase, the mother is finally perceived as a mixture of good and bad qualities, meaning that splitting is overcome,, and the child is increasingly able to regulate their emotions. It is this achievement that is lacking in borderline conditiions. For progression through these phases to occur, it is crucial that good-enough mothering be consistently available; otherwise the child can get “stuck” in a certain phase.

There is one area where I disagree with Rinsley. I don’t think it’s possible to put the phases of infantile development into a neat timeframe (as Rinsley attempts to do by saying that object constancy takes over in healthy toddlers at around 24 months, for example). I think children’s development is highly individual and that aspects of these phases continue to be worked on long after the first few years of life, even in emotionally healthy children.

Row 2: States of Self-Object Fusion or Differentiation

In this row, Rinsley indicates whether a person sees themselves and others as fused (indistinguishable from each other; this is a psychotic state), split (self images experienced as separate from images of other people, but viewed as all-good or all-bad, a borderline state), or integrated (seeing a mix of good and bad qualities within both self images and images of other people, a neurotic/healthy state). Roughly, fused self/object images relate to “psychotic” states, split images to “borderline” or “narcissistic” states, and integrated images to “neurotic” or healthy states of minds.

Row 3: Specific Diagnostic Categories

Here Rinsley lists diagnostic labels that correspond vertically with the phases of child development and self-object differentiation from the higher rows: Autistic-presymbiotic schizophrenia, symbiotic schizophrenia, bipolar disorders, borderline personality, narcissistic personality, neuroses, etc. I will not describe specifically what these diagnoses mean; the reader who is familiar with DSM categories will recognize them.

The crucial thing is that the diagnoses overlap along a spectrum and thus are not distinct illnesses. Rinsley conceptualized diagnoses as morphing into one another as treatment progressed; for example, one could start treatment at an upper-level schizophrenic, become a “borderline” a year or two later, then become narcissistic, and finally end up functioning at a neurotic, essentially healthy level after several years.

As conceived by Rinsley, diagnoses never represented fixed “illnesses” that one had to have for life. Treatment could change diagnosis; there was the prospect of transformation. American psychiatry has fallen far from this viewpoint with its current pessimistic views of rigidly separate “mental illnesses” that one can only “manage.”

This reminds me of how many years ago, I attended a National Alliance of Mental Illness meeting. At this session people talked about how mental illnesses were “brain diseases” that one could “learn to live with”. Even back then I thought that was a pathetic, limiting idea. Who wants to just “manage their illness” when they could become truly well? Having realistic hope that one can transform oneself is so much more motivating! In my opinion NAMI is not to be trusted, due to their reliance on drug company funding. This funding implies a tie to the hopelessness of the disease categories of modern-day psychiatry.

Row 4: Major Diagnostic Categories

Here Rinsley lists the broad diagnostic regions: firstly, psychoses, which include schizophrenias, bipolar disorders, and some lower-level borderline conditions. These conditions represent emotional arrests in the earliest developmental periods. They include people who have fused images of themselves and other people; i.e. the person cannot distinguish between themselves and other people at an emotional level (and they see themselves and others as all-good and all-bad).

The second group is characterological (personality) disorders. These include the borderline, narcissistic, and also schizoid disorders. These also exist on a continuum and flow into one another. They feature splitting as their primary defenses Such people can emotionally perceive differences between themselves and other people, but they still see themselves and others as all-good or all-bad. The shorthand “G (S O)” with the space behind S and O mean that good self and object images are perceived as separate from each other, but are not integrated with bad self and object images. By contrast, in the psychotic conditions, with S-O, the dash between S and O means that the person experiences a lack of separation or differentiation between images of themselves and other people; they cannot emotionally tell where they end and other people begin. This “fusion” phenomenon occurs in some people who gets labeled with severe borderline conditions, which are partly psychotic, but it is a chronic condition in schizophrenic states.

Finally, in the last major diagnostic group, the psychoneuroses, the psychic structure gets reorganized so that splitting is eliminated and the person can see good and bad qualities coexisting in both their self-image and in their images of others. The shorthand S (G B) means that good and bad qualities are perceived together in oneself and others without splitting.

Row 5: Quality of Internalized Self-Object Images

This row describes how supportive or comforting the person’s internalized images of other people are. The more positive experiences a person has had, the further to the right hand of this continuum they are likely to be. Unstable archaic images refer to states where a person feels psychologically unstable because they are not comforted by sufficient positive memories / internalized good experiences. This corresponds to psychotic conditions and to lower level borderline states. This deficit is the reason for the commonly cited inability to regulate emotions in Borderline Personality Disorder. I wrote about this in my article on Gerald Adler’s insufficiency model:

The “stable archaic introjects” refers to when a person uses splitting, but the positive images are predominant most of the time over the negative, so the person can regulate their feelings better. This corresponds to higher level borderline and narcissistic conditions.

Lastly, differentiated self and object states refer to the ability to see good and bad in the same self or other-image. In this way people can consistently be perceived as mixtures of good and bad. This makes truly mature relationships possible based on genuine caring and interest in the other person, as opposed to mainly using people for what they can do for you (as with narcissistic conditions), or being so deficient in supportive introjects that one has trouble comforting oneself or trusting others at all (as in borderline and psychotic states).

In this row, I listed Jeffrey Seinfeld’s four phases in a way that corresponds vertically to the horizontal continuums in the rows above. Borderline states are associated either with the upper part of the out-of-contact phase, or more frequently, with the ambivalent symbiotic phase. As one progresses into the therapeutic symbiotic phase – corresponding to being able to trust and feel supported emotionally by other people consistently – one stops being “borderline” and progresses toward healthier narcissistic and neurotic levels of functioning. It occurs to me that it’s too bad these words still sound pathological and negative. Again, we need better words to describe challenges in relating and functioning, words to give people hope of becoming fulfilled and well, not just managing an “illness”.

Please see the article below for a detailed description of Seinfeld’s four phases. Understanding the relative strengths of positive and negative self/object images explains how schizophrenic states can evolve into BPD, which can evolve into NPD, which can evolve into neurosis/healthy personalities, etc. Really, all of these conditions represents problems with adapting and managing life problems; rather than “brain diseases” Given sufficient support, all of these conditions can evolve or morph into one another along the left-to-right continuum of emotional growth. Here are Seinfeld’s phases:

And here is an example of how a young woman progressed through the four phases, starting in the lower-level out-of-contact “borderline” phase”, progressing through the narcissistic phase, and finishing in the neurotic-healthy part of the spectrum:

In this row, I put common DSM labels – schizophrenia, BPD, NPD, neurosis, etc. These are not truly valid illness categories, but they have some meaning if understood as part of a developmental continuum.

Below these labels, I put Lawrence Hedges’ descriptions of the four developmental levels which Seinfeld described in his phases. I haven’t written about Hedges yet, but he is my favorite psychodynamic writer along with Jeffrey Seinfeld. His descriptions of people’s problems are much more empathic, human, and hopeful than the DSM labels. More on Hedges in a later post.

My goal in this article was to give the reader a taste of how psychodynamic theorists think about schizophrenia, borderline, narcissistic, and neurotic-healthy mental states as existing along a continuum of emotional development. This viewpoint is different than the rigid DSM categories which dominate American psychiatry today.

In my opinion, this spectrum or continuum based approach, while not perfect, is more informative and realistic than rigid DSM categories. Since it is developmental, it implies the hope that one can grow beyond frozen emotional development to become emotionally mature. That’s why it’s my rough guide for thinking about “borderline” and “narcissistic” states, although I try not to use those words too much!

——————–

I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or are trying to help a borderline individual, I would be happy to listen to your story and provide feedback if possible. Feel free to provide constructive criticism of this site also.

This article is the opinion of a non-professional layperson, and should not be taken as medical advice or as the view of a therapist who is professionally qualified to treat Borderline Personality Disorder or any other mental health condition. Readers should consult with a qualified mental health professional before undertaking any treatment.